Lack of alignment, strategic drift – community pharmacy needs to wake up to the culture problem on its doorstep, Ade Williams writes

Before I start, I have a confession to make: I scrapped the original draft of this piece you are reading, having written it in a ‘cold sweat’ moment. The sunny uplands I was taking us to in that piece would have drawn a lot from the book written by a respected colleague and friend, Creating Strategy - A Practical Guide by Michael Bernard. 

My relationship with the author aside, this book really does merit the glowing reviews hailing it as one of the best readable and relatable books on strategy in recent memory. Michael is a font of knowledge with vast experience, and drawing from Michael’s ideas the title for my piece would have been: Why community pharmacy needs strategic alignment.

Pharmacy culture

Someone I know (okay, Michael) is fond of using the following quote by Peter Drucker to focus minds on the environment that enables success: “Culture eats strategy for breakfast.” Over the last few years, I can say that I have gained a reasonable understanding of community pharmacy’s culture. I can also, sadly, see how our jagged journey as we navigate the dire straits of fortune is indelibly tied to the culture we are too ready to embrace. 

I don’t mean how we look after our patients, serve our communities or support our teams, but rather how we seek to advance our case to paymasters and government policymakers.

Sometimes, we cannot identify the different identities, with varying priorities and objectives that sit behind the remit and accountability for these roles. This, however, is not where I am going today.

In times gone by, I have wondered what the NHS vision for community pharmacy was – and on the flipside, what exactly our strategy was. Both remain a mystery. It was never lost on me that most of what happens in community pharmacy demonstrates exceptional effort with little external support. 

The vision, yes, that inspiring portrait of ‘why’ my colleagues and I should feel encouraged and motivated to perform well above the stipulations of professional standards or contractual obligations, is still yet to be revealed, or at least coherently. When it lands, it could do so during the Pharmacy Show; it must tie community pharmacy with a broader NHS mission and desired goals.

In other words, the ‘what’ exactly needs to be achieved through our efforts through a sustainable framework. Then our clear strategy will emerge as a collective, rigorous and in-depth design work to produce a plan that defines how we intend to ensure the policy is achieved or, where necessary, needs changing.

Aligning decision-making across our sector will ensure that our strategies succeed and we will see clear results from our campaigns and work to influence, deliver and mitigate policy decisions and contractual arrangements. Community pharmacy rightly addresses the varying local population needs by embracing innovation and quality, not uniformity. 

Holding on to unified positions requires maturity and a shared common purpose – a sense underpinned to some extent by the threat of mutually assured failure. 

So, my piece was going to be about strategic alignment – how to continually get everybody to employ their effort in the way that best delivers the collective goal. I would not be the first to talk about this. It is one of the things that comes up most frequently in any deliberation on how to improve things. As our path to unity is frail, it may help change our culture.

Who got it wrong?

The examples of those who have got this wrong fill me with dread. MySpace, Toys R Us, Yahoo, Kodak, Nokia, Sony and Blockbuster, with their respective decisions now characterised by a failure to identify, fully appreciate or respond accordingly to sometimes complementary evolutions or sharp changes in the industry, public demands or possibilities that would lead to a significant loss to them and in some cases precipitate or hasten their demise. There is a phrase for this – ‘strategic drift’.

What are the proximate causes of this drift tendency? Culture and complacency are the ever-recurring themes. Worryingly, culture in this context inexplicably speaks about leadership. Not individuals, but collective failure. 

At a time of such seismic change across the health landscape, community pharmacy failing to advance would be a catastrophic failure. Worryingly, the first chapters of Michael’s book already tell me why.

Ade Williams is a community pharmacy contractor in Bristol